Tuesday, January 31, 2023

Comments by Marie

Showing 209 of 216 comments. Show all.

  • In my opinion the root cause of medicalization of childhood behaviors is the desire for pharmaceutical profits. Drug companies are not interested in what is causing distress, only in how much money they can make from suffering. And professions, such as psychiatry, that earn money from dispensing drugs support this trend. Finally, I don’t think we can absolve parents, teachers and actually too many people in general who are seeking easy answers from a pill.

  • I have read medical articles in the New York Times for many years. And for many years I’ve been struck by the poor quality of the newspaper’s medical reporting, not just in psychology but in other fields as well. It’s surprising that some of the reporters have degrees in fields that should make them conversant with critical thinking and statistics. But they’re often not.

    In the medical field, too many NYT articles simply regurgitate the conventional and often corrupt thinking of mainstream medicine. Sometimes smaller, less prestigious publications have far better articles on medical topics than the NYT.

  • Actually there is no OVERWHELMING evidence that childhood abuse causes schizophrenia. Certainly, some studies show an association, but most research is flawed and it’s obvious that there are other causes for schizophrenia than childhood abuse, which seems to put too much of the blame for the illness on parents.

    Bad things indeed do happen, and can drive certain people crazy. I knew a man who had a psychotic breakdown because he feared his wife was having an affair and he’d lose his family. But most people facing divorce don’t react that way.

    I also think there’s a huge difference between being pessimistic and realistic.

  • @Patrick, Steve, Jay. First, I’m not advocating for genetic research. I am saying that heredity is probably a factor in mental illness, as it is in many illnesses. Maybe no one has looked into the genetic causes of cholera, but they have looked into genetic causes of numerous disorders including diabetes and breast cancer. I agree there’s no hard evidence that there is a genetic propensity for psychosis. But what hard evidence is there for other causes of psychosis? If someday we have the tools to formulate a complete description of the causes of mental illness, heredity will probably be included. Currently, such tools don’t exist.

    Also, it is very optimistic to believe that we can combat psychosis by changing cultural dislocation, urban environment, family, social, cultural, religious, educational, geographical and political factors. There’s no reason to think this will ever happen.

  • This is an interesting article that points out horrific abuses. But there’s another side to the story.

    My husband is in a memory care center, bed ridden, with dementia, and with numerous physical ailments. He has been in Hospice for about a year and a half. When he was enrolled in Hospice he was close to death and our family was looking into funeral arrangements. The facility he was in was not giving him adequate care. Nursing homes and memory care centers are having a hard time getting enough help. Caretakers, good or bad, are hard to find. The Hospice nurse and her aides gave my husband the care he wasn’t getting (for one thing they treated and cured a dangerous wound on his heel), while offering support to him and to our family. My husband’s physical health improved. Hospice undoubtedly has extended his life. I can’t say enough good things about Hospice. Don’t ask my opinion of the memory care center.

    Now Medicare is threatening to remove my husband from Hospice. If they do, as seems likely, we’ll have to move him to a nursing home and our costs will burgeon.

    So, yes, based on this article, some Hospices are abusing the system. But the system itself is inadequate and there are some excellent Hospices that have filled the care gap.

  • What’s happening in Canada is mirrored in the United States. Pharmaceutical companies donate money to patient advocacy groups, which then support Big Pharma’s positions. Members of these groups complain to regulators, journalists and members of Congress that if pharmaceutical companies are reigned in research will be restricted and patients will die.

    As an aside, some of the media (Wall Street Journal editorial pages, for example) are no more than mouthpieces for pharmaceutical companies.

  • There is no doubt that adverse psychological and social factors are major causes of mental disorders. But I believe some people are more susceptible to having bad reactions to negative life events. So there must be some genetic component. In addition, there may be other factors that impact development of mental disorders, such as disease, anxiety provoking events and drugs.

    The interrelationship among all these things must be extremely complex meaning the DSM is worthless and putting people into mental disorder categories is inadequate for research and discussion.

    We might be able to move forward a little if researchers admitted the limitations of our state of knowledge.

  • The things you blame on capitalism have been found in many different systems and throughout history. Slavery, not just racism, but actual slavery, was common in Ancient Rome and Greece. It exists in many places in the world today. Burnout? I guess you have to have some kind of wealth to have the privilege to burn out climate change? Too many people is probably the root cause. Loneliness? That’s a problem in urban societies. I could go on, but I’m sure you get the idea.

  • Capitalism certainly has had some evil aspects but no more evil than that found in some of the societies you believe the capitalists oppressed. You ask! “ Why can’t systems built upon “cooperation, peace, love, and understanding” be made to work for the betterment of human kind?”. What systems have been built upon cooperation, peace, love, etc? Humans are filled with love, but also with hate, envy, a desire to dominate, and all sorts of other evil traits. And those despicable traits are dominant throughout history and in all sorts of systems.

    So that’s what’s funny about this article: It is simplistic.

  • This article is almost funny. Of course capitalism has huge faults. But so does every other socioeconomic system. Take this comment about “a connection between the poor work conditions of early industrialization and the illness and premature deaths of workers.” Do the authors really think circumstances were better under feudalism, where workers were virtual slaves to nobles.

    Were conditions better under Mao whose policies led to the starvation death of 45 MILLION people? Or do they prefer North Korea?

    Under capitalism in the United States children are educated and most people have health care and housing. Is it perfect? No. But what is.

    I wish MIA would no longer publish articles like this, which are ideological, show little insight and have only a marginal connection to mental health. There are intelligent, nuanced ways to criticize capitalism. This article isn’t it.

  • I don’t see that this study indicates anything. First of all BPD is a dubious diagnosis. How can this DSM created condition be studied when it is such a questionable disorder?

    Then there’s the admission that one of the therapies studied (eTau) included therapists who used “other approaches” to psychotherapy. Can we really trust that the remaining treatments didn’t also use other approaches? Maybe the good therapists just used what seemed to work. And I’m not even addressing the issue of the accuracy of the supposed improvements.

  • Actually a 15% response is not that bad when compared to the benefits of some other drugs. For example, statins, which are widely prescribed, will not extent lifespan or prevent cardiovascular disease for 98% of those without preexisting heart disease. Insulin given to those with type 2 diabetes will reduce blood sugar levels, but a major study showed marginal non statistically significant reductions in heart attacks, strokes, and maybe microvascular disease among those given insulin after 10 years of treatment.

    The point is Americans take numerous drugs whose benefits are minimal or nonexistent. Why this is the case is a good question.

  • That’s not completely true. I worked for pharmaceutical companies. Yes there were people who would do anything to advance themselves and company profits. It was very disillusioning. But there were also people who genuinely wanted to help patients, who were ethical and who would not go along with corrupt practices.

    And let’s not forget that pharmaceutical companies have developed life saving drugs (remember when childhood leukemia was a death sentence?).

  • There’s probably little point in trying to educate the public and doctors about the realities of medicalized psychiatry. That’s because psychiatry has become a religion to people looking to alleviate their distress. You can no more convince people suffering from psychosis or depression that psychiatric drugs are unlikely to help than you are to convince a Christian to abandon their faith.

    The problem is compounded by the fact that some of these drugs do work for some people (not the majority), something Robert Whitaker has acknowledged.

  • Millions of people have left Venezuela to escape poverty, hunger and the collapse of public services. Yet the “mental well-being” of Venezuelans is better than in the US? I don’t believe it.

    Let me just point out that the survey of mental health was done online so how representative is it of the most impoverished people in that country who undoubtedly don’t have access to the internet? In addition surveys in general can be very wrong and online surveys are especially unreliable.

  • Sera, I enjoyed your approach to the NYT article. It’s very creative to look at the comments as a way of showing how hard it is for so many people to accept alternatives to mainstream psychiatry.

    One of the points I made in my comment on the article was that since drug research has resulted in such minimal benefit, maybe funding should be diverted to other things, such as providing housing as well as social and psychological support to the mentally ill, something that was promised when mental hospitals started closing, but never happened to any significant degree.

  • I personally believe that taking an antidepressant during pregnancy is risky. But, having said that, this particular study is flawed. The group of women who stopped taking antidepressants when they became pregnant may be very different from the group that continued. So any conclusions are suspect.

    Frankly, I don’t understand why they even conducted a study with such a poor design. But this is not unusual in psychological research or, actually, in a lot of research.

  • I read the book on the MISTRA study a number of years ago, not the whole thing; I couldn’t get through it because it was so poorly written. I was very suspicious of the study at the time and criticisms I’ve read of it since then, including the one here, have just added to my skepticism.

    My original objections included that the methodology was slipshod, with the author insisting, for example that the twins didn’t exchange information because they understood the importance of not doing so and fully complied.

    Also, the book examined dozens of the twins’ traits. When that many comparisons are made at least some of the positive heritability correlations are going to be due to chance. This was never considered in the study.

    The study was also homophobic: homosexuality was discussed under the heading of psychopathology.

    That a study like this is still given credence indicates, once again, how misguided the field of psychology is.

  • Maybe I’m being overly optimistic (not typical of me), but this latest DMS ploy has generated a lot of anger. Could the psychiatric profession have gone too far?

    Hopefully this will result in more skepticism about psychiatry and make it just a little easier to effect change.

  • Forgive my skepticism. But when Venezuela gets one of the best scores something has to be wrong despite the caution that this reflects internet users. Here’s another possible explanation for these results: People from English speaking countries are simply more willing to SAY they are distressed or struggling than people in other countries.

    I see a political agenda here, claiming that residents of wealthier countries that prioritize individualism and achievement are more likely to be distressed or struggling. Even if the results of this survey are accurate (dubious in my mind), it’s not at all obvious what the cause is.

  • The only issue here, for me, is that if you think people are more mentally disabled today than in the past you have to have accurate statistics. If it’s easier to get disability checks more people may apply. So are people really more disabled or are the disability figures distorted. I don’t know, but if you’re claiming things are worse you should take into account what I just discussed.

  • I have no idea why you would say that life was less oppressive in Ancient Greece. Thirty percent of the citizens of Athens were slaves (there was apparently a bright spot though, flogging was illegal). Parents were allowed to abandon their babies. Others could take them in, but then the child became a slave. Historians say most people in Ancient Greece had a very low standard of living.

  • By faking it, I simply meant that lots of people claim to have disorders that will allow them to receive disability benefits.

    As for exploitation, the nature of work has often been exploitive or whatever you want to call it. The ancient Greeks and Romans, the Inca and Mayan civilizations, the ancient Egyptians all exploited the masses and slavery was common.

    Capitalism certainly has its faults, but most people, today at least, are better off under it than they would have been in, say, Ancient Greece.

  • This article deals with complex issues so I can only touch on a few things.

    First, employers certainly can exploit workers and often do.

    But the worker can also exploit the system ( I’ll concede to a far lesser extent than the bosses). I have no doubt many people claiming mental illness are faking it.

    But my biggest problem is the implication that poverty, discrimination and insecurity are transformed into medical problems to a greater extent than is the case with those who are more well to do. I’ve seen plenty of relatively wealthy people who suffer from depression, misery, anxiety, drug over doses, alcoholism, suicide and psychosis. What proof is there that the poor have any more mental issues than the rich?

    Life is very hard. Certainly wealthier people and people who do not experience discrimination have tremendous advantages. But is better mental health one of those advantages? I’m not so sure.

  • Unfortunately, failing to tell patients about the side effects of any drug is probably common. Physicians also often fail to discuss basic information, like how likely the drug is to help the patient. When doctors prescribe exceptionally toxic drugs like antipsychotics this failure to inform should be considered malpractice. But of course it isn’t.

  • This is an extremely depressing article because the sensible proposals suggested to improve the situation have no chance of coming to pass in the United States. In addition to all the problems listed in the article, we have a Congress that is owned by the pharmaceutical industry. In 2020, for example, more than two-thirds of senators and representatives accepted pharmaceutical campaign money.

    Big Pharma’s money has been well spent. Congress has been instrumental in weakening the FDA by allowing pharmaceutical funding of the agency and compromising procedures to approve drugs and medical devices through measures such as the 21st Century Cures Act.

    Yes, changes should be made. But with so many people and institutions profiting how is that going to happen?

  • I agree with you that psychiatry has little understanding of the mind and confuses it with the brain. But I still think some symptoms like OCD can be included in a diagnostic category even if there are several causes for the symptoms. And a good psychiatrist should be aware that treatments may have to be tailored to the individual. This is the case with some physical illnesses. For example, a stroke could be caused by a hemorrhage or a clot, but both types are called strokes.

  • “A psychiatrist consulting the DSM would likely diagnose someone with checking behaviors …….with obsessive compulsive disorder………In the process, a psychiatrist might find that they also qualify for anxiety, depression, or any number of other comorbidities.“

    “In HiTOP, by contrast, checking behaviors would be treated as just one symptom reflecting a position on a larger internalizing spectrum—a general tendency to experience strong negative emotions that can encompass qualities of OCD, anxiety, and depression simultaneously.”

    This is the problem: Why wouldn’t a person who had OCD feel anxiety or depression or another comorbidity?

    This new way of thinking doesn’t seem any better than the old.

    Eliminating diagnostic categories altogether, as in PTMF, seems a little better, but what about all those who have similar symptoms, as in OCD? Shouldn’t there be a way to capture this?

    Anyway, as long as insurance companies demand diagnostic categories I don’t see the DSM going away.

  • This is an important topic. I absolutely can see censorship of mental health positions that are not popular with certain influential groups. That’s why I’m opposed to censorship of anything that does not defame individuals. I don’t believe that “demoting bad medical information during a pandemic is a necessary strategy for saving lives.” Who is to decide what is bad medical information? The Facebook censors? The FDA? The groups that initially censored anyone who even suggested that Covid may have started in a Wuhan lab? At one time it was bad medical information to claim that many stomach ulcers were caused by a bacterial infection or that radical mastectomy was overused. Today many object to the routine use of antipsychotics in first episodes of schizophrenia? Should they be censored?

    In order to protect unpopular but possibly accurate information we should tolerate points of view which we are certain are false or even possibly destructive. Censorship has already gone too far.

  • I agree with some of the points made here, but I also have problems. There are people who suffer from serious disabilities and maybe illness is not a bad description for their difficulties even if there are no physical causes. For example, someone who is convinced the television news moderator is not discussing trade issues but is really talking about her, in code. Or the man who can’t leave his home because of overwhelming anxiety. One dictionary definition of illness is an unhealthy condition of body or mind.

    The DSM goes too far in its categorizing almost every problem that causes suffering or difficulties in functioning as illnesses. It’s so corrupt as to be almost useless conceptually. But that doesn’t mean that there are no illnesses of the mind. Or if you don’t want to use the term illness what term do you use?

  • I couldn’t get into this article and, frankly, I didn’t read most of it. Spitzer seems to accept that the DSM is a valid way to categorize psychiatric problems. I don’t.

    At one point he states, “this thing that we were influenced by pharmaceuticals is something that I just, I say, is just absurd.” I think all the DSMs reek of pharmaceutical influence.

    In addition, even though I like reading different points of view, I found this interview boring.

  • I’d like to add liar to your list of his misdeeds. Years ago he wrote an article for Medscape and attacked a physician who commented on his conflicts of interest. He blatantly and inaccurately denied receiving any remuneration from pharmaceutical companies. He did this despite the fact that Medscape had listed his conflicts of interest after the article.

    I have no problem with his being fired, though I still think it’s for the wrong reason.

  • Many popular drugs do not benefit most patients. For example, without pre-existing heart disease 98% of people do not benefit from statins and statins do not extend lifespan. There’s no adequate evidence that blood pressure medications help people with mild hypertension (under 89/139).

    I don’t think most people understand the limited benefit of many treatments physicians frequently prescribe.

  • I shouldn’t be surprised at all this, but the extent of the corruption is so mind boggling it’s stunning.

    One aside, the diagnoses the patient received are uninformative: PTSD, bipolar II disorder, alcohol use disorder in full sustained remission, cannabis use disorder, and borderline personality disorder. In plain English, he was an unhappy person, who used pot and was once an alcoholic. The DSM categories are even more vague than my description.

  • Yes, in getting these female sex drugs approved the FDA was corrupt and the pharmaceutical industry was devious and deceitful.

    But there is another culprit in this story: Physicians who prescribe an ineffective drug and don’t provide vital information to their patients. Who would take drugs with significant adverse effects after being informed that one of them can be expected to lead to an average of only one additional enjoyable sexual experience every two months and the other to none?

    I don’t know the percentage of doctors who prescribe ineffective and even dangerous drugs, but in my experience it’s not an insignificant number.

  • I’ve known for a long time about the corruption of the FDA, but for some reason approval of this drug was especially, dare I say it, depressing. Maybe it’s because of the blatant disregard for good science and patient welfare without even an attempt to justify a bad decision.

    What can we trust the FDA to do right? Can we even believe its endorsement of the Covid vaccines? Some drugs have helped people, but are these a minority of all those approved?

  • I can’t relate to this article. Why should therapists be more concerned about climate distress than other social distresses? How about too many people in the world distress, too much crime distress, poverty distress, inequality distress, too high inflation distress, too many wars distress, abortion restriction distress. I can go on.

    Therapy should deal with personal distress, like I have a serious illness I can’t get along with my wife, my children are failing in school, I’m depressed, I’m being persecuted.

    If a person is only upset about climate change, they shouldn’t go to a therapist. Become an activist if you want, change what you can, accept what you can’t change. As for therapists, let them decide what social issues they want to get involved in, if any; maybe it won’t be climate change. There are plenty of other challenges we face.

  • I have no doubt that these efficacy graphics are what stick in the minds of prescribers. But the misleading graphics are only misleading if they are not examined carefully and if other data from the studies are ignored. So the question is why are these prescribers (mostly psychiatrists I presume) so readily duped.

    Some of them are probably being bought off. But what about the rest? Are they really so trusting of pharmaceutical companies that they’ll believe whatever they’re told?

  • I have been unimpressed with New York Times reporting on health issues in general, not just psychiatry. The reporters too often rely mainly on pharmaceutical company hacks so that they then exaggerate the benefits of drugs while minimizing safety issues. Frequently they don’t seem to know the difference between relative risk reduction versus absolute risk reduction, and their reverence for studies means they accept them uncritically. Bakalar is one of the worst, although what he did in this article seems to be a new low.

    They sometimes have good health coverage, though Their coverage of the Alzheimer’s drug Aduhelm, for example, was excellent.

  • Excellent information on how corrupt the drug approval process has become. It makes me feel that before taking any drug an individual should do their own research. This is, of course, an imperfect solution because information is not easy to come by or understand.

    But I do have a question. Can a drug really be approved without at least one statistically significant result? The result may be for a surrogate marker or it may be a fairly insignificant result, but I believe the drug company has to show some statistical significance. Am I wrong?

  • Being affected by a problem is different from linking that problem to mental health. There’s an unfortunate tendency for too many things to be framed as a mental health issue. It’s one of the ways psychiatry has insinuated itself into all aspects of society.

    I have a vision (or is it a nightmare) of the next issue of the DSM adding a disorder called youth climate change anxiety.

  • I had a very hard time relating to this article. I really think health professionals have more important things to do than address climate change. I’m sure young people are unhappy about global warming. But how about their distress at Covid lockdowns, gun violence, incompetent therapists, over medication for such things as depression and ADHD, social difficulties exacerbated by Facebook manipulations, and the excessive burden of student loans.

    I’m not convinced that global warming is a major factor in the mental health of most young people.

  • I read an excellent book a few years ago, Oligarchy by Jeffry Winters, that basically examined how the wealthy in various countries have controlled society from Ancient Greece to the present. Based on this book and my own observations, I doubt that we can overturn any political system enough to take away the power of the financial elites. Revolutions often just replace one group of oligarchs with their rivals.

    That drug companies can be so openly corrupt while aided not only by the medical profession, but by Democrats and Republicans is only one manifestation of the power of the super wealthy.

    I’m not completely pessimistic. Even within an imperfect system we can have better outcomes. We’ve all seen improvements in our country. Some examples are Medicare, the end of segregation, and more equality for women. I suspect, though, that if we did move beyond a capitalist profit system, the results would be different but not better than what we have today.

  • Pharmaceutical companies have to follow a protocol that they submit to the FDA. This protocol is reviewed by the agency and by an Institutional Review Board, which is supposed to protect study participants. The drug company and the FDA collaborate on many aspects of the study.

    Yet the drug companies still sometimes get approval for drugs that are poorly conducted. My question is will adding another layer of reviewers to what is already an extensive process really lead to better trials?

    I agree that making trial data accessible is a good idea, but that it probably won’t happen. Nonetheless, the information already available in published studies often gives us enough information to see whether the trials are well done. Often it’s obvious they’re not.

    I also think the public is generally unaware of the limited effectiveness of many of the drugs they take. I don’t think some people’s reluctance to get a COVID vaccine is because of a mistrust of medicine in general.

  • This is a very good article that points out more reasons to mistrust medical research.

    I sympathize with the author’s desire to try to improve the situation. But I question whether better and objective criteria that will lead to fair quality assessments are possible given the huge profits involved. These profits not only encourage deception, but give interested parties the resources to manipulate public policy.

    I hope I’m being too skeptical and that at least some beneficial changes can be made.

  • There’s no doubt that conservatorship can be abused. But some parts of this story don’t make sense. How did two tax preparers break into a home, steal records and kidnap someone. Why didn’t the police do something? Why wasn’t an attorney called to prevent this miscarriage of justice?

    How was the mother’s entire estate transferred to a step granddaughter in less than a week? In my experience the court system simply doesn’t work that fast. I don’t know what the situation is in California, but in Illinois even someone with dementia can retain an attorney to protect their interests. Why wasn’t this done?

    I could go on. But parts of this narrative really need more explanation.

  • Dr. Gøtzsche presents some good criticisms of the Cochrane review of antidepressants in children. And I think the review should have been far more critical than it was. Specifically, given the lack of credible evidence, they shouldn’t have suggested that antidepressants might sometimes be considered because their findings “reflect the average effects of the antidepressants, and given depression is a heterogeneous condition, some individuals may experience a greater response.”

    But I want to point out that the Cochrane abstract was hardly a resounding endorsement of the pills. It said:

    “Findings suggest that most newer antidepressants may reduce depression symptoms in a small and unimportant way compared with placebo. Furthermore, there are likely to be small and unimportant differences in the reduction of depression symptoms between the majority of antidepressants.”

  • This is an excellent article, but there’s one other thing that I’ve found adds to polypharmacy and that’s the belief that many patients have that every drug they take is beneficial.

    I used to point out to people the non benefit or low benefit of some of their drugs. No more. Many people are convinced their medications are extending their life span or helping them in some way.

    People want something to give them hope in the face of debilitating (or even not so debilitating) disease. No one wants to hear there’s nothing more to be done and US physicians, for many reasons, usually won’t say that. At one time religion or a shaman may have provided hope. Now it’s often drugs.

  • That 20% of health research is fraudulent is shocking. But the problem is even worse because much research, if not outright fraudulent, is misleading.

    Medical research often cites relative risk statistics, for example, which greatly exaggerate the efficacy of a drug. And there are many other ways researchers massage their findings as MIA has often pointed out.

    Just one example, a study on statins claimed they are effective in preventing heart disease in the elderly, but the study combined those with heart disease and those without to come to that conclusion. The researchers also did not adequately address the lack of a mortality benefit, claiming lack of statistical power to do so, something I don’t believe.

  • Government has been coopted by these industries, so it’s not much help.

    It’s not easy to get accurate medical information. Big Pharma has its tentacles into so much. In addition to what’s been mentioned, it influences medical journals, journalists, physicians, and governmental agencies. I don’t want to be too pessimistic though. There are good sites and accurate information out there. Unfortunately many people don’t have the technical or general knowledge to be able to separate facts from propaganda.

  • A very sad story, but the problem is far worse than indicated here because so many medical associations and organizations that supposedly are patient advocates accept pharmaceutical money. Take the National Alliance on Mental Illness (NAMI), for example, which lists pharmaceutical companies as sponsors. NAMI is typical.

    Beware of online medical advice because so much of it could have been written by the PR department of any pharmaceutical company. One (admittedly minor) example is WebMD’s assertion that brain chemicals in people with ADHD may be out of balance.

    It’s not a pretty picture.

  • Racial equity in all research is important, but this article does not confront the major issue: Are drug companies, who will be aided and abetted by the FDA, promoting psychedelics as a way of coopting currently illegal substances in a blatant attempt to increase their obscenely high profits? I’ve already observed a lack of concern about the substantial bad effects of psychedelics on the part of advocates of this new treatment.

    I also feel legalization is coming because there’s so much money involved. But this concern about including people of color in the research seems to me to be just an additional way of attempting to legitimize a questionable endeavor. Making sure these “treatments” are available to marginalized communities is only fair, but let’s face it, it also increases the number of people the pharmaceutical industry will be able to profit from.

  • Fast track approval has been abused by the FDA and, as this article points out is often based on surrogate markers, like amyloid plaque. Unfortunately many drugs are based on these surrogate markers, not just those that are fast tracked. Examples include cholesterol medications for people without heart disease, which do reduce cholesterol but do little or nothing to increase longevity; and blood pressure medications for mild hypertension, which reduce blood pressure but may have no other benefits.

    I don’t expect the FDA to change its fast track or other approval protocols as long as both Democrats and Republicans are corrupted by pharmaceutical company money and permit such regulatory malfeasance to continue.

  • Incredible, but not surprising.

    I once worked for a pharmaceutical company that submitted a new drug application to the FDA. My boss kept warning that the data was inaccurate, sloppy and unreliable (not all people who work for drug companies are dishonest). She was ignored. The FDA rejected the application and basically accused the company of fraud.

    I observed some other questionable practices, but that was the most egregious.

  • I would just like to add one other major way drug companies fool patients into believing a drug is far more beneficial than it is: reporting the relative risk reduction of a drug instead of the absolute risk reduction. Depending on the study it could appear that a drug is effective 90% of the time, using relative risk reduction, while the more meaningful absolute risk reduction might show as little as 1% efficacy.

    Newspaper articles often present the misleading relative risk reduction when writing about a new drug I think partly because the new drug would seem so worthless they’d have nothing meaningful to write about if they reported the absolute risk reduction.

  • This is the state of too much medical research today: Conducted by people who ignore good science in order to gain financially. Unfortunately the United States government is going along with this sad state of affairs as is most recently evidenced by the FDA’s approval of a worthless, expensive and dangerous Alzheimer’s drug.

  • I read this book a few months ago and basically enjoyed it ( I’ll get to the basically shortly). The novel describes the ways pharmaceutical companies have (among other things) lied, distorted clinical trial results, hidden side effects of their drugs, and attempted to sell medications for all sorts of conditions whether these medicines can help or not. As a former medical writer, I was engrossed by how accurately Scott describes some of the really evil things that are going on. Scott describes the trials and tribulations of a journalist who gets burned when he publicizes some of the wrong doings of a pharmaceutical company. He also follows that company’s guilt-ridden ghost writer as she has increasing doubts about her role in the company’s deceptions. The depiction of those two main characters is decent. But Scott goes overboard in what pharmaceutical companies can do as for example when he lets the chief villain erase all proof of the existence of a main character. No way. My other objection is the jazzy writing style Scott uses. It may not bother everyone, but I didn’t like it. For example, “Yeah, conno-f….ing-rations. Lobster bake-on the beach is going to get us some sunsetty fantasy shots.” Or “Mad honeys, the full Abercrombie.” But for me the pleasure of reading a nicely plotted novel that so satisfyingly exposed the wrongdoings of the pharmaceutical industry outweighed the book’s faults.

  • Of course you’re right. Many common treatments offer no benefits to most patients for whom they’re prescribed. But there’s another factor here. People have an insatiable desire for physicians to do something to help them. What physician would dare say, yes you have a greater risk of a heart attack because of your family history, blood pressure, age, and cholesterol level, but I have no drugs that can help you, or at best there’s only a slight chance the drugs will be beneficial? For many people the medical field and the physician have taken the place of religion and the medicine man. A doctor who refuses to fill this role will lose patients. It’s hard to believe revolutionary change is coming any time soon.

  • There’s no doubt in my mind that the use of psychedelics to treat problems ranging from anxiety to depression to schizophrenia is coming to psychiatry. I don’t think the reason is that these drugs will necessarily be beneficial but because there’s money to be made. The legalization of marijuana has shown that the public may be willing to accept expanded use of psychedelics, drug companies see a new way to cash in on a trend and therapists can try new approaches to mental illness. I can’t say no one will be helped. But some people get relief from antipsychotics and antidepressants even if the hype goes way beyond what the statistics support. Minimized in the discussion for now are all the deleterious effects from psychedelics, including death.

  • Part of the problem are the consumer advocates that attempt to pressure the FDA (of course the drug companies may play a big part in organizing these “advocates”). It has happened before. The FDA approved a Duchenne muscular dystrophy drug in 2016 despite limited data showing efficacy and a negative panel recommendation. There were many desperate parents who ignored the evidence and pushed for approval. And that’s only one example. It’s obvious that the FDA is not always objective.

  • I have lost respect for the Cochrane Review. I recently read their research on maintenance therapy with antipsychotics and was stunned by its poor quality. It’s conclusion: “For people with schizophrenia, the evidence suggests that maintenance on antipsychotic drugs prevents relapse to a much greater extent than placebo for approximately up to two years of follow-up.” It failed to mention the problems with the studies that allowed them to reach this finding. One example, it ignores the fact that patients in the placebo groups have often been abruptly withdrawn from treatment, which could lead to relapse. It claimed long term studies could be difficult to interpret because of such things as environmental factors. I wouldn’t trust anything the Cochrane Review comes up with.

  • Actually I’m not surprised at these findings. How many patients know how to research their doctor’s conflict of interest or understand its importance? Medical journals accept pharmaceutical money and universities have their own conflicts of interest. So their indifference is to be expected. And how many physicians, especially psychiatrists, have an incentive to support tougher laws when they’re benefitting from pharmaceutical grants and gifts?

  • My experience with physicians and SSRIs has not been positive. Years ago a psychiatrist prescribed an antidepressant for my son (for anxiety). He wound up in the ER with the feeling that his whole body was on fire. The ER doctor said it was the SSRI. When my son called the psychiatrist, he said no way it was the drug and wanted to increase the dose. I’ve had two internists over the past 10 years. Both wanted me to take an antidepressant (not for depression). The second doctor was so insistent I lied and told her I’d think about it. You can say change doctors, but I think most of them are that way. Concerning antidepressants, the medical profession abetted by the FDA, has been irresponsible.

  • There is no doubt that antipsychotics are extraordinarily toxic, are over prescribed, and don’t “cure” psychosis. In addition, I have no doubt that few psychiatrists explain the dangers of antipsychotics to their patients, which is nothing less than malpractice. Nonetheless, some people suffer so much from a psychotic condition that antipsychotics may be the only help currently available. Such a prominent psychiatric critic as Joanna Moncrieff, for example, has written, “I still think antipsychotics can be useful, and that the benefits of treatment can outweigh the disadvantages, even in the longterm for some people.”

    Other toxic drugs are prescribed at times because nothing else is available, for example, chemotherapy for cancer. That antipsychotics may have limited usefulness under some circumstances does not mean that they are not misused most of the time.

  • Of course trying to break the blinding of a study is unethical. But I question whether these researchers are also duping the pharmaceutical industry. As I said in a previous post people can improve even when they know they’re taking a placebo. In addition, this study was small and flawed and it’s not clear, to me that the FDA would permit this ploy, at least I hope not.

  • Hopefully the FDA will not accept this devious attempt to break the blinding of a study. But who knows. The FDA has not always acted in the public’s best interests. Also, since it’s been found that people can improve even when they know they’re taking a placebo, this ploy may not work as well as the pharmaceutical industry would like. The study also has serious limits. It was a single blind, very small trial and, according to the researchers, there was no independent monitor reviewing sites’ work. So there may have been “inaccuracies” to hype the results.

  • I know it’s false to claim that only drugs are effective for psychosis, having personally known two people who had psychotic breakdowns , never took drugs and are now doing fine (employed, married, children, friends). One for 20 years, the other for about 8 years. So why does the press ignore studies that show this can happen? Because the press generally reports mainstream points of view, not only in the field of psychiatry but in other health fields as well. Reporters are often not experts in the areas they cover. They’re frequently weak in statistics and interpretation of clinical. trials. They’re also afraid to counter mainstream thinking and established “experts,” fearing they might do harm. I don’t see this changing any time soon.

  • I wouldn’t be too concerned if people don’t want to take statins because they don’t work very well, despite all the hype from the pharmaceutical industry. A study in the BMJ showed that with a statin, death was postponed between 5 and 19 days in primary prevention trials (people without heart disease) and between 10 and 27 days in secondary prevention trials (people with heart disease), with a median postponement of 3.2 and 4.1 days, respectively. Also, the trial mentioned in this article was very small and I’d be curious to know whether the researchers had conflicts of interest. The overselling of drug treatments as being effective, including antidepressants and antipsychotics, is commonplace.

  • I’m not convinced. The most I can say is that there may be some, maybe just a few, adults who do recover memories of childhood abuse, but it’s also possible that many such “recovered memories” are really false. No study cited in this article proves anything one way or another. For one thing, I question the contention that a trusted therapist would not have the same influence as a family member. Therapists can have a tremendous impact. Maybe delayed memory is as reliable as continuous memories, but that’s not saying much because continuous memories are often not that dependable. I truly doubt there are convincing studies of “recovered” memories. In general, most social and psychological research that I’ve seen has not been of the highest quality. The McMartin preschool case should not even be mentioned in a discussion of memory. It was one of the most egregious miscarriages of justice ever perpetrated. And that is one of the major problems of this article. It combines too many disparate cases, McMartin, abusive priests, Sandusky, incestuous parents. The bottom line for me is that nothing in this article proves that the weight of evidence is on the side of a genuine recovered memory vs a false memory when someone makes such a claim. Maybe. Maybe not.

  • Interesting comments. But I have a question. Are some of you saying that almost ALL people who are suffering from what is called “mental illness” (such as severe depression, bipolar disorder, schizophrenia) are reacting to severe abuse or horrible situations in their environment? I’m not denying that is sometimes the case. But how often? What is the relationship between innate vulnerabilities and mental breakdowns? Some people can be unable to function because they lost a job. Other people confront illness, death of loved ones, divorce, etc. and still manage to go on. I don’t think we know what leads to “mental illness,” except that there are undoubtedly numerous causes. And wouldn’t that mean we should accept various treatments, as long as they’re reasonable of course.

  • A very sad story. When as many as 13% of US boys have been diagnosed with ADHD you know something is wrong, not with the kids, but with psychologists, psychiatrists and educators. Why do so many boys supposedly have ADHD? Because boys are more difficult to control in school and drugging them is an easy fix. Psychiatrists and the pharmaceutical industry make money off an ADHD diagnosis and support short sighted educators in promoting this dubious condition. This article points out the dangers of being so irresponsible.

  • Dr. Pies should do a Google search. Not only has psychiatry promoted the chemical imbalance theory in the past, but the theory is still being promoted on many prominent websites.

    The Mayo Clinic says problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. As for depression, the Mayo Clinic cites one cause as abnormal or impaired neurotransmitters.

    WebMD says studies show that certain brain chemicals that control thinking, behavior, and emotions are either too active or not active enough in people with schizophrenia.

    The American Psychiatric Association says brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry.

    The Merck Manual says there are numerous causes of depression. One theory focuses on changes in neurotransmitter levels, including abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), glutamatergic, and serotonergic (5-hydroxytryptamine) neurotransmission.

  • Interesting article. Unfortunately, most of the complaints concerning psychological research has been made about many other fields. To give just one example. It is a common criticism of medical studies that journals and authors suppress or ignore negative results leading to over reporting of positive findings. Biased abstracts and the refusal to share raw data are also commonplace along with the undue influence of special interests.

  • I agree about the consent, but he wasn’t so demented that he didn’t basically understand. The man I’m talking about who underwent ECT was in a state of terror. He not only threatened violence, but actually attacked people a couple of times. He didn’t experience any pain. He wasn’t tortured. I was as skeptical as anyone about the supposed benefits of something that makes little sense. But it worked. And this man’s quality of life improved immensely.

  • I have no doubt that there are no RCTs proving the efficacy and safety of electroshock therapy. I’m certain it has harmed people. But. An elderly relative with dementia recently was in a psychiatric hospital agitated, depressed, suicidal, convinced the hospital and his son were conspiring to cut out his organs and sell them to the mafia for millions of dollars. He threatened violence. Nothing was helping and his psychiatrist suggested electroshock therapy. He consented to it and his desperate family agreed. It worked. His delusions disappeared, he calmed down, his depression lifted and he was able to be transferred to a memory care center. Several months later the family has observed no bad after effects. I’ve heard of other cases like this. Maybe the reason ECT has persisted is because it is sometimes effective.

  • I have no doubt marijuana can be harmful, having experienced a feeling of being split into two personalities after smoking pot when I was in my 20s. The feeling lasted for several days. It wasn’t the pot, because no one else had a similar experience and it wasn’t an underlying psychosis because it never happened again. Nonetheless, the study cited here is not convincing and seems to have been poorly done.

  • Sera, my main point is that women are STRONG. We do not have to obsess over a relatively unimportant article that would have received no attention if it had been written about a man. True misogyny is obnoxious. But to keep looking for it makes us victims and is disempowering. As for leftist vs. rightist, well Melania Trump was often disparaged and I saw very little liberal concern about that. I predict that the same kind of attacks on Jill Biden will not be overlooked.

  • Lots of people are saying the term doctor should not be used by Ph.Ds, including Sera Davidow. So yes this kind of argument is being made to tell men not to call themself doctor. As for the word kiddo, again, Joe Biden used it to refer to his wife and the author of the WSJ article was simply referencing that. By doing so, Epstein certainly wasn’t being deferential. But treating high ranking individuals this way has become commonplace. Now you (me too) wouldn’t write an article on this topic, but Epstein and the WSJ do seem to know how to get attention.

  • I have a very hard time getting really getting involved in this argument, which seems to be mostly about leftists and rightists finding yet another excuse to attack each other. Personally it makes me feel good to call a physician by the honorific doctor simply because that term means they have achieved a certain educational level that should make me, hopefully, respect their opinion. If someone with a ph.D gets a kick out of referring to themself as doctor, I really don’t care, and I don’t think it elevates them or demeans anyone else to do that. I do get a little more riled at calling someone misogynistic simply because he used the future First Lady as a way to criticize the term doctor and because he used the term kiddo (apparently because that’s a term president-elect Biden has used to refer to his wife). I think it wasn’t the smartest way for him to start his article, but do you know how many dumb things I read every day? Maybe we should all calm down and not be so sensitive about truly unimportant subjects.

  • This is a very good article. The only thing I strongly disagree with is this:
    “Depression has become big business for the pharmaceutical industry, psychiatrists, psychologists, therapists, and a whole host of other players. It has been promoted as a lucrative brand for several decades now (although I don’t doubt most who promote it do so out of a genuine desire to help people).”

    Except for some low level uninformed physicians and therapists, I think that most of the people who promote it are mainly looking out their own financial self interest.

  • I believe that the way autism is defined today is overly broad and is a subjective social construct. The term is so nebulous I don’t see how it could be used in meaningful research. However, I do think a narrow definition, such as the one used 50 years ago, which described very severely disturbed children, may have had merit.

  • Whether autism is overdiagnosed depends on how you define autism. Should an individual who has a very low iq, who can speak only a few words and who cannot interact with others at all be put in the same “autistic” category as someone who is intelligent, very verbal, and able to interact socially even with difficulty. To me that doesn’t make sense. I understand that accepting the label autism is a comfort to you. And a lot of educational, financial and social help for children having difficulties probably depends on applying this label. But I suspect there’s also a downside to putting children in a categorical box and encouraging them to see themselves as having a disorder instead of seeing themselves as being like everyone else with their own unique strengths and limitations.

  • Many years ago, when I was a newspaper reporter, I did a story on autism. At that time (late 1970s, early 1980s) the condition was defined very differently than it is today. Among other things, autistic children didn’t make eye contact, didn’t respond appropriately when spoken to and were unable to function. The condition was obvious from infancy, when such children didn’t even smile at their parents. For my story, I visited a small group home for autistic adults. Meaningful communication with them was not possible. Today, I see articles asking why the number of children with autism has increased so drastically. To me the answer is simple: the definition of autism has expanded to include all sorts of behavior that would never have been considered autistic decades ago. In this way, a very rare condition has become a relatively common one.

  • An article on ADHD appeared in the NYT last week (is It Possible To Outgrow ADHD, https://www.nytimes.com/2020/11/13/well/family/is-it-possible-to-outgrow-adhd.html). The article, and most of the comments to the article, accept the conventional psychiatric propaganda concerning ADHD, with some commentators being insulted when anyone had a different point of view. I wrote 4 comments to the article (3 were in response to individuals I disagreed with). My comments were posted, then 2 days later were all removed. This experience confirms my belief that it’s going to be very difficult to change the way psychiatry is practiced. It seems to me there are increasing attempts to suppress non-mainstream opinions.

  • I just read a summary of this study in Medscape, a website providing medical information to health professionals. The headline stated that Psilocybin provided “remarkable” relief for severe depression, a claim I found inaccurate give the limitations of the study. Your article was far more informative and was a pleasure to read. However, I am suspicious of these preliminary results, given the pharmaceutical industry’s push to cash in on the ingredients in hallucinogens and given the shameful history of so many pharmaceutical-backed psychiatric studies. The overhyping of the results of this study to medical professionals makes me feel even more strongly that caution is warranted

  • The VA article does not concentrate on antipsychotics. Just one other point. Is it really clear that more “ill” patients can do better off antipsychotics than the less ill? The problem is how illness is determined. Maybe a person who has the inner strength to refuse medication is not as sick as their symptoms might suggest, for example. In other words negative and positive symptoms may not be the best indicators of an individual’s potential for recovery.

  • The evidence and research does not disprove my argument because there are no conclusive studies.

    The Harrow study: The Harrow study, along with other studies, definitely show the severe limitations of antipsychotics in the long term treatment of schizophrenia. Nonetheless, Harrow has said that better outcomes in non-medicated treatment of schizophrenia is associated with internal characteristics of the patients, including better premorbid developmental achievements, favorable personality and attitudinal approaches, less vulnerability, greater resilience, and favorable prognostic factors.

    Wunderink: Interesting, small study.

    VA study: Not sure what you’re referring to. What drugs were they taking?

  • Forgive my skepticism when someone claims a drug or treatment is good for a very wide variety of things. Ms. Dejong hopes psychedelic therapies can be used for the treatment of end-of-life depression and anxiety, alcohol and drug addiction, dementia, anorexia and other eating disorders, cluster headaches and chronic pain. Really? In decades past didn’t the promoters of snake oil make such claims?

    I’m also perplexed as to why MIA has featured what seems to be an advertisement for the author’s business interests (and yes charities are a business). It would be interesting to look at psychedelics, the good and the bad. This article doesn’t do that possible subject justice.

  • It sounds as if there were many possible reasons for the schizophrenia prevalent in the Galvin family without having to even suspect a genetic cause. I also am convinced there is no strong genetic component to mental illness (meaning no specific gene or genes). However, I do believe that some people are more fragile and more vulnerable to adverse life events than others. Of course, I could be wrong. I base this simply on my own observations, not on any scientific study. I observed, for example, one person become schizophrenic over a possible divorce, while most people don’t react that way. I know someone who was at the Twin Towers on 9/11 who had a schizophrenic breakdown. Most people, though extremely distressed, didn’t. So heredity, who we are, may play a role in the development of mental illness. It could be argued that there are environmental reasons for vulnerability and undoubtedly there are, but does experience trump heredity. We just don’t know. There are probably very complex interactions.

  • @Sylvain
    The story of the Polgar sisters is interesting. And I have no doubt that hard work, etc. is necessary to create a genius. But it’s not obvious that any child can be made into a genius based solely on environmental factors. It’s as certain to me that there are genetic factors as it is to you that there aren’t. It’s not true that if early genius were inherited it would be passed from parent to child. There is such a thing as regression to the mean. Anyway, I don’t think either of us can positively prove our point of view.

  • I agree that twin studies are very flawed (I was especially incensed by the MISTRA). But heredity obviously plays a role in making people what they are. For example, a photographic memory, and an extraordinary musical ability (Mozart was writing compositions at the age of 5) must be largely dependent on genetics. The problem with the twin studies is they overreach in what they claim is inherited. You point out the extensive flaws in their methodology and reasoning. Maybe someday we will be able to disentangle the interaction between heredity and environment. But at this point, I don’t believe that we have the tools to do that.

  • You make some excellent points. But I’m suspicious of your characterization of Cuba. Yes, it provides doctors to other countries. But these physicians have been described as slave laborers with the Cuban government keeping a huge percentage of their salary. The Cuban medical system gives far better care to the elites than the common citizen (see the NYT article https://www.nytimes.com/2020/05/23/opinion/sunday/how-cubans-lost-faith-in-revolution.html). Bribes to doctors are common. Some pharmaceutical successes do not make Cuba a giant in the field of medicine. I’m opposed to the U.S. embargo, but even without it an authoritarian system like that in Cuba is not going to succeed overall for the ordinary person.

  • I suspect there are two reasons why the websites are so consistently inaccurate concerning antidepressants. First, drug company donations to the sites along with pharmaceutical ads. Second, the possibility that these sites copy information from each other, accurate or not. It would have been helpful to know which websites were reviewed in the study.

  • Excellent article. I’ve often wondered if at least part of the reason Americans don’t live as long as people in other developed countries is because of the number of drugs they take. Physicians are a major cause of this travesty. They prescribe antidepressants for everything from transient depression to anxiety to trouble sleeping. Statins are another category of drug that are indiscriminately prescribed (do physicians tell their patents that the chance of a statin helping a person without heart disease is 2% at best). The assault on children who are unnecessarily prescribed ADHD drugs and then prescribed other drugs to counter the bad effects of the ADHD drugs is unconscionable. Even worse are the number of children who are prescribed antipsychotics for reasons that include behavior control. Among those complicit in this perversion are medical societies that accept pharmaceutical funding. So many people are making money from our drug obsessed culture that I don’t expect to see any major changes in the near future.

  • “There is nothing inherently wrong with using medical writers in the publication process, as long as they are given credit on the byline for their work.”
    I don’t completely agree with this. For many years I worked as a medical writer for a pharmaceutical company. I didn’t write journal articles, but the medical writers who did had minimal input in the final product. Their work was heavily edited and was scrutinized by researchers, statisticians and managers. The job of the medical writer was to make the research data readable and to put it in a form acceptable for publication. I don’t believe that deserves a byline. Maybe at some companies the medical writer had more control over content. I don’t know, but if that’s the case a byline would be warranted.

  • You make a very persuasive case that that suicide prevention efforts and treatment with antidepressants increase suicide rates. But you also state that antidepressants help some people and that VHA mental health services decrease rates of suicidal ideation and suicide attempts.

    So is there a way to target antidepressant use mainly to those who will benefit? And is there a way to give mental health treatment only to those who will benefit and not to those who will be harmed? Or do you feel that antidepressant use and VHA treatment are so deleterious that these approaches should be abandoned, even if some people are helped?

  • Your experience with the NAMI affiliate you worked for sounds horrendous. I am very suspicious of NAMI because it accepts pharmaceutical donations and has a drug-centered approach to treatment. But, I understand that some affiliates are better than others, and the one, very brief, encounter I had with a local affiliate was positive. Nonetheless, I would never support NAMI. It is too uncritical in its support of drug treatment for such things as ADHD, anxiety, depression, and psychosis. But this is what I would expect from an organization that is funded, even if only in part, by big pharma.

  • Anticholinergic drugs may indeed increase risk for dementia. However, a study such as this can only suggest not prove causality no matter how many sensitivity analyses are done and how many confounding factors are checked. The increased risks presented in the article refer to relative risk. This kind of statistic is often used by researchers to overstate their case for the efficacy of a drug or in this case possibly overstate the dangers of anticholinergics. The article should have provided the absolute risk of taking the drugs. I am very suspicious of many drugs (including very common ones) and firmly believe they are over prescribed especially for psychiatric conditions. But it doesn’t help the case against these drugs to present incomplete information.

  • The idea that by being white you have more privilege than non-whites is a really simplistic concept. Your other categories of privilege are also suspect. Christian? I’ve known many happy and extremely successful Jews. Male? Some of the most successful people I’ve known are women. Heterosexual? There are plenty of very successful gay people, especially in the arts. Black? I’ve known very successful black men and women, and what about our last president. I could go on. The fact is that no matter what characteristics you have there will be positive and negative impacts from the social structure that you live in. Do some groups benefit more than others? Yes. Is society unfair? Yes, but in many ways that your concept of white privilege doesn’t even touch on. And whether you intend it or not, you are insulting white people.

  • I was enjoying your article Sera until you insulted me by saying “Not all white people. Because even the best of them are somehow benefiting from the systemic oppression”. Well, my white mother who came from Sicily was terrorized by a drunken abusive father. She worked for low wages in a sewing machine factory until she retired. How did she benefit from the systemic oppression? Or me, for that matter who had to struggle to make it through school and work without the benefit of knowing how to navigate through middle and upper middle class society because my working class parents didn’t have the knowledge to teach me. There is no reason, Sera, for an article on NAMI to veer off into a gratuitous attack on white people who are supposedly enjoying some unspecified privileges.

  • I believe that adult trauma can also lead to a psychotic experience. I personally know of two incidents. In one case a man in his forties had a breakdown after he found out his wife was having an affair. He became terrified they would get a divorce and he’d lose his family. His psychosis lasted several months. He briefly took medication. The second person I know had a breakdown that lasted a year. Her trauma was related to 9/11. She took no medication. In both cases there was a full recovery.

  • Years ago I read Born Together-Reared Apart, a book by Nancy Segal about the MISTRA study. I skimmed a lot because I found the book to be poorly written. I wasn’t convinced the study’s methodology was adequately vigorous. The study came up with all sorts of amazing similarities in the lives of the twins, but Segal dismissed critics who assumed the twins exchanged information. No way, said the author, because the twins understood the importance of not doing so and fully complied. She presented no proof of this assertion Also, the study compared dozens of the twins’ traits. When that many comparisons are made at least some of the positive heritability correlations are going to be due to chance. How was this problem handled? As far as I could tell it wasn’t. It also annoyed me that at one point homosexuality was discussed under the heading of psychopathology. Incredible. The fact that the researchers won’t allow the raw data to be examined is very suspicious. Based on my own criticisms and what you and others have said, I’m convinced this study is worthless.

  • I’m glad to see that in this instance the Cochrane review took into consideration whether a drug was sponsored by a pharmaceutical company. It didn’t do that when it supported the use of statins for primary prevention in 2013. The independence of Cochrane became even more questionable after it’s board expelled Peter Gøtzsche. I used to think Cochrane conducted unbiased rigorous research. Now I don’t believe that’s necessarily true.

  • Very informative commentary. I know MIA is a mental health website so I understand an article emphasizing how psychiatric drug dealing is killing Americans. And I can believe that psychiatry is the worst offender in our pill-pushing medical culture. Unfortunately, Americans are being harmed by pills given for many other diseases and non diseases. Doctors prescribe statins for people who have no heart disease under the unproven assertion that it will help them. Diseases are created (like pre-diabetes and pre-hypertension) and then pills are prescribed to treat these conditions. Thresholds for having a disease are lowered so more people can be prescribed drugs. And pharmaceutical-sponsored studies over-emphasize the benefits of the pills they sell. To stop abuse of psychiatric medications, we may need to pass laws and create regulations that address the abuse of all medications.

  • I started questioning Cochrane’s objectivity after it supported the use of statins for primary prevention in 2013. Among other things, the Cochran Center did not address the fact that all the studies it used in its review were either partially or completely funded by the pharmaceutical industry. The removal of Gøtzsche from Cochrane further supports my belief that the organization has moved away from being unbiased and scientifically based.

  • The STAT article obviously ignores the data Robert presents. But the authors seem to be making the argument that if the TREND toward increasing use of antidepressants had continued after 2004, adolescent suicide rates would not have gone up. In other words if there had been enough of an increase in antidepressant use, the adolescent suicide picture would be better and, by implication, the drop in suicides after the black box warning is insignificant. So while Robert is looking at the actual data, the STAT authors are looking at what they believe might have been if antidepressant use trends had continued. Their contention must be based on a belief that antidepressants are so beneficial that no other proof need be offered. I guess, because their thinking isn’t clear to me. The STAT article obviously errs by not looking at what has actually happened and addressing that issue.

  • In a recent Medscape article that Jeffrey Lieberman wrote on antidepressants he stated in the comments section “I have and do not receive any financial remuneration from Pharma or biotech. it’s a matter a public record”.

    I wrote a comment pointing out that at the beginning of his article, under disclosures, it states: Jeffrey A. Lieberman, MD, has disclosed the following relevant financial relationships: Served as a director, officer, partner, employee, advisor, consultant, or trustee for: Clintara; Intracellular Therapies
    Received research grant from: Alkermes; Biomarin; EnVivo/Forum; Genentech; Novartis/Novation; Sunovion
    Patent: Repligen

    I questioned why there was this contradiction and he replied: “I consult to them as I believe it is important to guide Pharma’s development of drugs, but I received no payment.” He then quoted his “full disclosure,” in which it was obvious he does receive compensation, as stated in the disclosure statement put in by the Medscape editors. I won’t call Dr. Lieberman a liar. But then what is he? This exchange indicates to me that at least some psychiatrists are not fooling themselves; they’re actively trying to mislead.

  • This article shows that fraud is present not only in psychiatry but throughout medicine. The writer is correct. It’s very difficult to accept much of medical research because it’s funded by the pharmaceutical industry. This industry also pays off “respected” medical journals, physicians, researchers, federal and state government officials, congressmen, and medical associations.

    In spite of all this, there are people, even in industry, who do try to do the right thing. But some are blatant in their acceptance of the fraud. As one commentator to this article said: Integrity doesn’t pay the bills. “Sorry, kids, we lost the house. Mr. Integrity here isn’t getting any more research projects.” (got 3 likes). Too many others try to delude themselves into believing they really are unbiased when they obviously are not.

    It will be very difficult to correct the wrongs being perpetrated in psychiatry when the corruption is so widespread, but we have to try.

  • What you say is extremely reasonable. Unfortunately in a society where physicians use drugs to solve all sorts of problems, change is unlikely. Too many people benefit financially by maintaining the status quo. The NNT is high for many drugs commonly promoted (by doctors and medical associations as well as by pharmaceutical companies). For example:
    Statins for people who have no heart disease: at least 104
    Anti-hypertensive medication in people with relatively non-severe high blood pressure: 118
    Daily aspirin to prevent heart attack or stroke in people with no previous heart disease: 1167
    Bisphosphonates to prevent fractures in those with low bone mineral density: 50 for primary prevention

  • I agree there’s plenty wrong with capitalism. But there’s also a lot wrong with socialism, communism and every other ism ever devised by man. I feel we’ve just got to get along the best we can in a very imperfect world. As for personality tests, I think they’re mainly designed to figure out if an applicant will fit into the company culture. Suitable applicants will know how to answer the questions because they understand the job for which they’re applying and they understand the company. Truth is irrelevant and the company knows it so no one’s being deceived. It’s just part of the game. If someone doesn’t want to play the game, well, that is a problem if they want the job.

  • I personally found application personality tests to be humerous. Really, asking a person who’s applying for, say, a sales job whether they’d rather curl up with a book or go to a party on a Friday night is pretty funny. It never occurred to me to be in the least bit honest on these tests. I just answered questions the way I thought the company would want the ideal employee to answer them.

  • The powerful deleterious effects of psychotropic drugs have been documented in pharmaceutical company supported clinical trials (though many of these trials have undoubtedly underestimated the harms). And adverse effects can linger long after an individual discontinues a drug. It’s simply not true that stopping a medicine will necessarily stop the harm it causes. People who have been harmed by drugs are indeed victims. Because a drug causes a chemical effect on the brain and body does not mean the chemical imbalance theory of mental illness is correct. That is a logical fallacy. A drug could have no biological benefits and still have biological adverse effects, as ALL drugs do. You minimize this problem by claiming people can overcome the harms caused by medication by changing their attitude. The institutional effects you mention may be real, but that is a separate issue.

  • If African-American children are not receiving the same “standard of care” for ADHD as their white peers it may be to their benefit. This is because that standard of care involves overdiagnosis, over medication and unfortunate labeling of a child as somehow deficient. The solution should be to label and medicate white children less, making them more equal to their black peers. This will make the white kids better off and the black and white kids more equal.

  • This is a very suspect study. There were only 10 subjects. The “study” was poorly done. The criteria to determine whether individuals actually had Alzheimers was, well, at times ridiculous. Example: individual forgot where he put his keys. More serious symptoms could have been caused by such things as depression, anxiety, or over obsessing about perceived deficits. Finally, it appears that the authors are selling something called the MEND protocol. They can’t be trusted to be objective. This article is really not something MIA readers should be directed to.

  • After reading this excellent article I googled the Lancet Psychiatry study. Maybe I didn’t look hard enough, but there was universal acceptance of the study’s conclusion that individuals with ADHD have a brain disorder. This was the case on sites that are written for the general public as well as on sites written for health care professionals. Unfortunately, I’ve found that the problem of fake science is not limited to psychiatry. It is rampant.

  • All drugs have adverse effects. In order to decide whether the side effects are worth it you have to know if the drug has a good chance of helping you. For example, chemotherapy can cause death. Why would anyone take that risk for a drug that might provide no benefit? Deregulating the FDA makes us all guinea pigs just like those three women who went blind after (unregulated) stem cell treatment.


  • I sympathize with thewritejerry. I have contributed to MIA and have read it for years. I don’t appreciate being denigrated.
    I know plenty of educated, intelligent, nonbiased people, including women, who voted for Trump not because they liked everything about him but because they disliked Clinton more. If MIA wants to engage in attacking people whose politics they don’t agree with (and, based on this article, don’t understand) I may have to reconsider my support.

  • Another question I have concerning genotyping is the extent to which it would add to preventing adverse drug reactions over what is already available. Physicians can easily access information on drug-drug interactions (although, unfortunately many don’t do this). They should also take into consideration a patient’s age when determining drug dose (also not always done). If another test is going to be added to the numerous tests Americans undergo it should be cost effective. And the genotype test itself should be tested to see how well it works in practice, not just in theory.

  • Problems with P450 enzymes are only one source of adverse drug reactions. Genotyping might help prevent the accumulation of too much drug and therefore prevent some bad side effects. But can’t even desirable levels of a drug wreck havoc with the body? For example, a statin may lower cholesterol, but since cholesterol is used by every cell in the body can’t that cause severe disruptions? And might not the increased level of seritonin in the brain caused by taking an SSRI cause unforeseen problems even at drug levels that are deemed desirable.

  • I agree so much with your article. Concerning the schools, not only can they get extra money but they (psychologists, social workers, administrators) have been brainwashed by psychiatric orthodoxy. I know of at least three children who would have been put on medication by schools. In each case the parents refused and in each case the children turned out fine.

  • Thanks for your response, but I disagree with you about pre-diabetes and pre-hypertension. Because of big pharma, standards as to what constitutes diabetes and hypertension have been lowered. Lifestyle changes to treat these “conditions” probably won’t do much, so the next step is medication. Here’s one of many articles you could read concerning pre-diabetes.
    And here’s one on pre-hypertension.

  • As always I thoroughly enjoyed your blog Philip. I’d just like to add that although psychiatry may be the worst offender, expansion of the list of “illnesses” is rampant throughout our health care system. I’m thinking of such diagnoses as low sex drive, pre-diabetes, pre-hypertension, and the push to put huge numbers of healthy adults on statins. All of this is driven by the pharmaceutical industry with the help of its medical collaborators. It is aided by journals that accept ads and by medical associations that depend on pharmaceutical funding.

  • In an age when medication is considered by many to be the only treatment for severe mental illness, it is good to see Dr. Steinman write about his success using psychotherapy to help very disturbed individuals. It brought to mind. A book I read many years ago, I Never Promised You A Rose Garden by Joanne Greenberg (published in 1964 under the pen name Hannah Green). This was an autobiographical novel in which the author described how she was cured of schizophrenia through psychotherapy with Frieda Fromm-Reichmann, a famous psychiatrist at the time. The author went on to be married and have children along with a sucesssful career. Since the book was published it has come under criticism from psychiatrists who claim Greenberg never really had schizophrenia, because, I suppose, they just can’t believe psychotherapy can cure a supposed brain disease.

  • I also think MIA should consider who actually did support Trump. The media would have you believe his support was overwhelmingly uneducated, racist, working class male bigots. This is not true. One example: A MedPage Today survey taken shortly before the election showed 50% of its readers intended to vote for Trump. This newsletter is written mainly for physicians and other healthcare professionals. In 2008 and 2012 The readers said they would vote for Obama.

  • I think these comments show why MIA should not get involved in this election. At least one person who commented believes the US took a step toward fascism and another argued that Trump won because he played to the lowest political denominator and they showed up to vote for him. I consider this a vicious slur since I know people who voted for Trump who are decent, educated, not racist, and not hysterical. They had good reasons for voting for a flawed candidate because they couldn’t tolerate the other flawed candidate. Remember almost half of voters supported Trump. Does MIA really want to alienate these millions of people. This divisive argument does not belong here. There’s no reason to lose support over an issue like this.

  • I agree with you. In addition, since almost 50% of voters voted for Trump I don’t see any reason for MIA to unnecessarily alienate readers who may not share the point of view that Trump is Satan. He certainly was a flawed candidate but then so was Hillary. I think MIA should stay focused and not get mired in presidential politics.

  • A professional who commented on Dr. Pies’ article stated that he could attest to the fact that quality of life declines precipitously during the time patients come off their medications. He contended that if those in a placebo group are suffering from withdrawal during the course of a study, that could skew results considerably and asked if any studies compared outcomes with medication naive groups or subgroups.

    Dr. Pies answered that there are no such QOL studies that he is aware of. He said such issues could be dealt with by very slow tapering (usually 3-6 months). But he also claimed that “supersensitivity psychosis” because of withdrawal is speculative, and he dismissed the commentator’s observations by saying the concept of a withdrawal effect is only theoretical. Of course, in his article he claimed a superior ability to judge the effects of psychiatric medication because of his work with patients. So apparently anecdotal evidence is important, but only if it doesn’t contradict Dr. Pies.

  • I wondered if Dr. Frances ever apologized for taking pharmaceutical money to do the schizophrenia practice guidelines. Apparently he did in a 2015 blog where he stated:

    “…it was very unwise to do guidelines with drug industry funding. Even though they were fairly done, accurately reported, and contained built in methodological protections against industry-favorable bias, the industry sponsorship by itself created an understandable appearance of possible bias that might reduce faith in the sound advice and useful method contained in them. It was an error in judgment on my part that I apologize for. I have learned from my mistake and hope others do as well.”

    He still does not publicly admit that there’s no way to protect against industry bias when a special interest funds your research. And, of course, he does not acknowledge that the guideline was not fair, sound, or useful, even with the information available at the time.

  • I can possibly see telling a patient that taking an innocuous sugar pill will help them in order to make use of the placebo effect. Possibly. I’m really not sure. But antidepressants are not benign. So it is malpractice (or should be malpractice) to deceive a patient by telling them that an antidepressant will be effective when its side effects include sexual dysfunction, insomnia, weight gain, suicidal ideation, and who knows what else. Does the good doctor inform his patients that trying to get off the drug if they do have adverse effects could be problematic? The arrogance of Dr. Carlat’s position is stunning.

  • One of the (many) things that is upsetting is that Dr. Carlat justifies telling patients that antidepressants are effective in order to enhance the placebo effect. Frankly, I can possibly see making that argument if antidepressants were benign drugs. So to tell a patient that taking a pill composed of sugar will help them may have some justication. I’m really not sure. But it is malpractice to tell a patient that a drug is effective when its side effects include sexual dysfunction, insomnia, weight gain, possible increase in suicidal ideation, and who knows what else. Does the good doctor inform his patients that trying to get off the drug if they do have these adverse effects could be problematic? The arrogance of Dr. Carlat’s position is stunning.

  • It’s not surprising that psychiatry wants to expand its power and profitability by calling criminal acts illnesses. But I suspect it can do this because it is a common belief that criminals are ill. I can’t tell you the number of times someone has told me an abusive individual, a murderer , a child molestor or even someone with nothing more than a very bad temper is “sick.” And, I believe, this attitude is more prevalent among better educated individuals who are in the higher socio-economic strata.

  • I loved your analysis of the GSK funded study. I suspect that physicians and the public believe the statements in abstracts at their own risk. Because bipolar disorder is widely accepted as real I think it’s always interesting to call out errors in studies of this supposed illness, errors that Dr. Pies should have caught. I believe that psychiatrists who accept money from drug companies and think they are still objective are often deluding themselves.

  • I know two people well who had psychotic epidodes after traumatic events. One is a man who had a breakdown in his 30s. He thought, among other things, that a tv talk show host was talking about him in code and some waiters were poisoning his food. He was working at the World Trade Center and was diagnosed as paranoid psychizophrenic several months after the destruction of the twin towers. He refused medication, eventually recovered, and has had no further breakdowns. The second is a man in his 40s who discovered his wife was having an affair, feared that she might divorce him and was terrified he’d lose his kids. He couldn’t sleep for five days. He started having crying fits, thought someone put poison gas in his car and that his house was bugged. The psychiatrist diagnosed him first as schizophrenic, then as bipolar and blamed his sleeplessness on his illness, not even considering that such severe sleep deprivation could cause psychosis. He took an antipsychotic briefly and stopped because he didn’t like the way he felt. His marriage crisis resolved and two years later he’s fine. I personally have no doubt that trauma can precipitate a psychotic event.

  • Actually the article makes some good points. Namely, that conflicts of interest can include departments, research institutes, universities, nonprofit funders, such as the National Institutes of Health and foundations, and journals. The authors also point out that the pursuit of fame can lead to conflicts of interest, and they discuss the dangers of public-private relationships, although they don’t put it quite that way. Unfortunately, the positive aspects of the authors’ article is overwhelmed by their proposal to replace the rightfully pejorative term conflict of interest with the benign phrase confluence of interest. This absurd wordsmithing exposes the authors’ real motive for their article. Obviously, conflicts of interest have strongly influenced them and, it seems, JAMA.

  • This kind of approach is why 11% of American children ages 4-17 are diagnosed with ADHD, with many of these children being drugged. My guess is most of us have at least some trouble concentrating on boring, mundane tasks. And if you’re immature (i.e. young), it may be even more of a problem. This doesn’t mean you have a disorder. And it doesn’t mean you need to be given potent medications.

  • You very effectively expose how hypocritcal Dr. Lieberman was and what a sham diagnosis ADHD is. When my grandson was about 10 he was diagnosed with ADHD because he supposedly wasn’t concentrating adequately in school (his parents refused medication). When it was pointed out that he would spend hours reading books in his room, the psychologist said that was only because he was interested in the books, so that didn’t count. Being able to concentrate on video games also didn’t count. If the ADHD diagnosis wasn’t being so widely used to harm children by drugging them, I would consider it humorous to imply that you have an illness if your mind wanders because you’re bored.

  • You have written an excellent article that expresses many of the negative feelings I have about psychiatry. The only thing I may disagree with is how gullible reporters are. I have read many articles in major newspapers on clinical studies (not just psychiatric studies). Unfortunately, the reporters frequently appear to have have little knowledge of statistics and simply parrot what the study authors misleadingly feed them. Too often these articles sound like PR for the study. Usually the articles don’t mention the study authors’ conflicts of interest.

  • I wrote this comment in the NYT on Lieberman’s article.

    “Sure, let’s force the mentally ill to take antipsychotic medication that can result in inner agitation, weight gain, brain shrinkage, tardive dyskinesia (involuntary movements), and reduced life spans. All on the off chance that we might, just might, prevent a few violent acts. Civil rights? Why should the mentally ill have any say whatsoever in their treatment? Do we really want to give psychiatrists, many of whom are notorious by the way for having extensive ties to the pharmaceutical industry, the power to dictate who must take drugs? Jeffrey Lieberman, for one, has accepted money from companies that include AstraZenica, Bristol-Myers Squib, and GlaxoSmith Kleine. Surprise! He supports forced medication of the mentally ill, not all of them, he assures us. Just the ones psychiatrists (like him?) determine to be a danger, using their crystal balls, I assume.”

  • John, the researchers state that the drug apparently “lost efficacy.” They make an assumption that the most severe cases with expected worse outcomes took more medication, thus explaining the poor results. But they say their statistical analysis may not have been correct. I don’t see this as meaning that the whole body of conclusions as to what happened after month 14 is suspect, just that what they were trying to prove (the worst cases took more medication) is suspect. Maybe I’m wrong, but that’s the way I read it.
    My understanding is that the composition of the groups did not vary in a completely unknown manner. If children taking the drug at year 3 were doing worse than they were at month 14 and worse than children no longer taking the medication, you might question if the medication stopped working. This may not be definitive, but it’s certainly something to be explored further. And it casts doubt on the efficacy of the medication. Also, RCTs are not the only things that can be used to question the efficacy of a drug.

  • Your quote from the original authors says they don’t know why the ADHD medication stopped working. But it did stop. Other studies have also cast doubt on the efficacy of ADHD drugs. If I were a parent I’d be very reluctant to have my child take an ADHD med given the side effects of the drugs, the tremendous push by the pharmaceutical industry to promote the drugs, and the continuing questions about how well they work. An RCT wouldn’t necessarily be definitive since those kind of studies can be (and have been) manipulated.

    As an aside, I’m also very suspicious of the concept of ADHD. A psychologist once diagnosed my 10 year old grandson with this supposed condition. When it was pointed out that the child could concentrate on reading books he liked for hours at a time, she said that was only because he was interested in the books. If lack of interest makes it hard to concentate, then maybe almost all of us have ADHD.

  • The primary endpoint may have been 14 months, but the study authors chose to follow up and what they found was disconcerting. Of course the results of the follow up should have been emphasized. Let’s say a follow up study of a drug found an increased number of heart attacks in those who took the study medication, certainly this should not only be reported but publicized. It is true that the children who stopped treatment may have differed from those who did not. But according to Whitaker and Cosgrove, at the end of 3 years the researchers found that if anything the off-med group had more severe symptoms early in the trial. My own personal feeling is these facts cast not some doubt but severe doubt on the benefit of ADHD meds for most children.

  • The really sad part is that if this drug is approved many women will take it not knowing how marginally effective and dangerous it is. They will do this because they trust their doctors to do what is best for them. When I was younger I also trusted physicians. No more. Every doctor I go to wants to prescribe drugs for even minor conditions. They never discuss side effects, efficacy or drug interactions. For one thing, to do this would take too long. For another, most physicians know very little about the medications they so freely foist on their patients.

  • I read Friedman’s NYT’s opinion piece when it was first published and, like you, was disturbed by it. It was thus a pleasure to read your excellent critique of the piece. I just want to emphasize one point. I do not feel that the NYT provides quality news and information, at least not in its reporting of health related studies (including psychiatric studies). The articles on these studies often read like press releases for the study authors. They exaggerate the benefits of treatments and drugs by reporting relative risk statistics instead of more meaningful measurements like number needed to treat to obtain the desired results. The reporters do not appear to have enough statistical knowledge to adequately question the study authors. And they often don’t report conflicts of interest. So Friedman’s op ed fits in very well with the unsatisfactory approach the NYT takes to its health reporting in general.

  • I’ve also observed that many, many physicians are poorly informed about drugs. I’ve seen them inappropriately prescribe antidepressants, statins, antibiotics, and sleep aids, not to mention Ritalin, and antipsychotics. I too wonder if they get most of their information on drugs from pharmaceutical company reps. But even if they don’t, there is a tremendous amount of misinformation on drugs to be found in medical journals that publish drug company influenced studies and on popular websites that I believe have been influenced directly or indirectly by pharmaceutical companies. These companies also pay physicians who they identify as opinion leaders to try to promote their drugs to other physicians.

  • I want to first say that I never mentioned bipolar because I believe it is one of the most abused diagnoses in the psychiatric lexicon.

    I agree that there are problems with the reliability and validity of severe depression and schizophrenia. But it seems to me that there are validity and reliability questions surrounding medical conditions that are known to be diseases. I’m no expert, but Alzheimer’s disease and sinusitis come to mind.

  • I agree with your point about medicalizing human conditions. And saying that people who are struggling with problems in their lives have a disease is demeaning.

    It is also clear that the pharmaceutical industry wants to create diseases in order to increase the market for its drugs. Questionable “diseases” certainly include ADHD, mild or moderate depression, low sex drive, pre-anything (pre-diabetes, pre-hypertension), and obesity.

    But it seems to me that whether conditions such as severe depression or schizophrenia are considered diseases depends on the definition of disease. Certainly these psychological states are not diseases if disease is defined as a condition of the body or one of its parts that prevents normal functioning, that produces characteristic signs and symptoms, and that has known or unknown chemical or structural causes. But if disease is defined as a disorder of normal functioning, couldn’t these conditions be considered a disease? Certainly it is abnormal if you can’t get out of bed for a week because you’re too depressed, or if you’re in a constant state of panic because you think everyone is talking about you on TV.

    I hate to give any ground to psychiatry, which I have personally observed as too often corrupted. But I do question whether no psychiatric condition should be considered a disease.

  • I’m writing, again, to my senators and representative about this outrageous bill. I think everyone who opposes it should do the same. Of course, they won’t read my email, but I’m sure they’ll tally up how many are opposed and if there are enough maybe the congressmen will think twice about voting for it.